Provider Demographics
NPI:1689478745
Name:MCCARTY, MELISSA OTILIA (PSYD, LP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:OTILIA
Last Name:MCCARTY
Suffix:
Gender:
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:OTILIA
Other - Last Name:WOLFGRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 E 28TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3799
Mailing Address - Country:US
Mailing Address - Phone:612-262-3464
Mailing Address - Fax:
Practice Address - Street 1:800 E 28TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3799
Practice Address - Country:US
Practice Address - Phone:612-262-3464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist